A step in the right direction

From the July 22, 2009 edition of The Journal Record
By Stephen Prescott

How will you measure the success of the government’s health care reform initiative?

If you’re a liberal, the make-or-break issue may be the inclusion of a government-run plan that competes with private insurers. Ditto – but the opposite – if you’re a conservative.

Or maybe your hot button is how much money is set aside to cover the uninsured or whether there are incentives for behavior that promotes good health.

These are all important issues. If I had to pick one health care reform initiative we absolutely must have, I’d choose comparative effectiveness.

The concept is simple: If researchers can gather data comparing the effectiveness of competing drugs, medical devices or operations for a specific condition, then patients and their doctors can make better decisions about the most effective and safest treatment.

Yet, we often don’t have such information for common problems.

So, notwithstanding the tremendous strides we’ve made in understanding human disease and devising new ways to remedy those conditions, physicians are too often making treatment decisions based on guesswork.

Take, for example, prostate cancer.

If you were diagnosed with slow-growing, early-stage prostate cancer (the most common form), you’d be presented with a menu of treatment options.

One option would be “watch and wait,” where you’d do nothing other than continue to have your condition monitored to ensure the cancer did not progress. You’d also be offered numerous other potential courses of treatment, including surgery to remove the prostate gland, a targeted form of radiation known as I.M.R.T. and proton radiation therapy.

You also might be offered supplemental hormonal treatment.

Some of these approaches have substantial side effects, and others have very few. The cost of these different treatments varies considerably, from a few thousand dollars to more than $100,000. All are typically reimbursed by private and public health insurers. But what you and your doctor wouldn’t have is a straightforward mechanism to know which one is more effective at keeping you alive – with the fewest side effects. Or whether that is one of the more (or less) expensive options.

As I said, this is just an example. The same general obstacle is faced every day by countless patients and their physicians, all of whom are trying to make the best decisions to protect health.

In the stimulus package, there is $1.1 billion for research to compare the effectiveness of medical approaches to a wide variety of medical issues, from the treatment of prostate cancer to preventing hospital infections.

These funds are a great start. Still, these are stimulus dollars, so they’ll be gone in two years. And if we’re to take the issue of health care reform seriously, we need to continue looking at what works and what doesn’t well beyond 2011.

Red or blue, few would argue that the success of any health care reform rests on our ability to know which treatments work best. Then we can ask how much they cost, because if we try to cut costs first, we may cut in the wrong place.

To continue to keep our eyes shut to the risks and benefits of different courses of treatment is not only inefficient, it’s downright unhealthy.

Stephen Prescott is president of the Oklahoma Medical Research Foundation.

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